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GP funding formula changes to be announced by autumn

NHS managers are looking at revising GP practices’ funding formula to take greater account of deprivation, they have told Pulse, with plans likely to be announced by the autumn for inclusion in next year’s contract.

NHS England has set up two groups to finally recommend changes to the Carr Hill formula, which has included representation from campaigning London practices who are pushing for the formula to take greater account of deprivation.

However, the GPC has warned NHS England to proceed with caution, as any reworking of the formula will likely have the unintended consequence of destabilising other practices instead.

But NHS England has told Pulse that it is currently working on the formula.

A spokesperson said: ‘We continue to work with the [GPC] on the review with the aim of adapting the formula to better reflect workload and deprivation. This work continues and we will communicate further in due course.’

They added: ‘We have previously committed to reviewing the GP funding (Carr Hill) formula and we restated this as part of the wider New Deal for General Practice.’

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Representatives from Tower Hamlets in east London – where there has been a long-running campaign to weight practice funding towards deprived areas – are advising NHS England chief executive Simon Stevens.

NHS Tower Hamlets CCG chair Sir Sam Everington, an adviser to NHS England and a GP in Bow, told Pulse that they were consulted by NHS England on the Carr Hill formula.

He said: ’We wanted to challenge the whole funding system in the country for primary and secondary care, because a lot of the system is based on the age of a patient.’

A team in Tower Hamlets undertook research that showed that consultation rates for a 55-year-old in a deprived area is the equivalent of a 75-year-old in a non-deprived area.

He added: ‘Now that has massive implications in terms of funding… it challenges the Carr-Hill formula.

‘Simon Stevens came to Tower Hamlets and was presented with this information and was very taken by it. That is why he asked Dr Kambiz Boomla [the GP who led the research] in particular to get involved in any new funding formulas.’

Virginia Patania, managing partner at the Jubilee Street practice and a member of NHS Tower Hamlets CCG governing board, said there had been discussions around a ‘local solution’ to the potential practice closures in the London borough as a result of the withdrawal of MPIG.

However, Miss Patania - who has been instrumental in leading the Save Our Surgeries campaign - said any agreement would be ‘an interim step until deprivation is fully acknowledged in the Carr-Hill formula, which is being revised as we speak currently’.

She said: ‘We hope that will be complete possibly by autumn and that it will have a sufficient impact to sustain general practice as of April of 2016.

‘Between now and 2016 we just really need to identify a local solution that can then be replicated by other practices across the country.’

However Dr Richard Vautrey, deputy chair of the GPC, said: ‘Since the review only just got going it is really hard to say when it will conclude. There are two groups involved and [Dr Chaand Nagpaul chair of the GPC] is involved on those from our side as well as some of our technical folk.

He said that the GPC position ‘is as it was before and has been for many years’.

Dr Vautrey added: ‘[We feel] any benefits from changing the formula were outweighed by the destabilising effect it would have on practices because of the winners and losers that it would cause and we need to bear that in mind when looking further at the formula.’

Alarm bells are ringing loudly. Re-calculation for what London wants?We have a huge prevalence of extremely elderly in my practice, twice the national prevalence, and they consume vast amounts of GP and nurse time and create a huge home visit list. We feel deeply aggrieved that the elderly are already badly under-represented in the Benny Hill weighting formula so that we are grossly underfunded for the work involved. Taking money off us to give to another group that is already given extra weighting will go down very very very badly indeed.

As usual there will be winners and losers but there are practices in our area which have >50% of their patients with severe deprivation while some practices have less than 5%.

HSCIC statistics shows 14.7 % of A&E attendances are from Most deprived (adjust for size of cohorts) while its 6.x % for the least deprived.However HSJ quotes that the least deprived patients consume 1.8% more NHS resources than the rest of the population adjusted for size).Go figure that!

The Carr-Hill formula effectively finished my old practice. I resigned before we went down. After a stringent PMS review a practice in a relatively well off area just outside London we were only being paid for 75% of our patients. Deprived no, but very demanding with high expectations. Essentially we had just over 2000 patients who were not funded. Whatever formula is used there should be narrow standard deviations from the mean for those at either end, so that there are no horrendous losers and no massive gainers.

The bottom line is :Is the total amount of money going to all practices actually increased?Otherwise , the fallacy is they just move money around , a bit more to 'deprived' practices and a bit less to the others. The total lump sum remains the same.The worst scenario is a new but more 'efficient' Benny Hill formula to save even more money.Watch the space, mate........